Arthroscopy: The Journal of Arthroscopic & Related Surgery
Meta-AnalysisOutcomes and Risks of Operative Treatment of Rupture of the Anterior Cruciate Ligament in Children and Adolescents
Section snippets
Study Questions
Within the framework of this meta-analysis, we addressed the following key questions:
- 1
Given the current best evidence, how likely are complications and good functional results after surgical treatment of ACL ruptures in immature patients?
- 2
Does suturing of the ruptured ACL offer successful outcomes, or do these injuries require ligament reconstruction?
- 3
If ligament reconstruction is necessary, which type of graft, drilling technique (physeal sparing v transphyseal), and anchoring method (next to
Study Profile
A total of 1,234 articles were retrieved (Fig 1), and 55 articles were considered suitable for this study. These included a total of 935 patients with 941 knees that received surgical treatment for a complete ligamentous rupture of the ACL. The study profile according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations28 is illustrated in Fig 1. We could not identify any randomized or quasi-randomized controlled trials, prospective cohort studies, or
Discussion
This study represents the first meta-analysis of the surgical treatment of ACL rupture in patients with open growth plates. The specific risk of growth disturbances in patients with open physes must be respected when choosing the optimal treatment strategy. Overall, the surgical treatment of ACL ruptures in children and adolescents was associated with low complication rates and promising functional outcomes.
In comparison with adults, an additional risk of growth disturbances in patients with
Conclusions
This meta-analysis showed generally low rates of leg-length differences, axis deviations, and graft failures after ACL reconstruction in skeletally immature patients. Hamstring transplants may lower the risk of the occurrence of leg-length differences or axis deviations, and physeal-sparing techniques may increase the risk. Randomized controlled trials are needed to clarify important issues in managing ACL ruptures in children and adolescents.
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Cited by (198)
Enlarging the evidence base for optimal treatment of paediatric ACL injuries the Paediatric Anterior Cruciate Ligament Initiative (PAMI)
2022, Sports Orthopaedics and TraumatologyOutcomes, Including Graft Tears, Contralateral Anterior Cruciate Ligament Tears, and All-Cause Ipsilateral Knee Operations, are Similar for Adult-type, Transphyseal, and Partial Transphyseal Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft in Pediatric and Adolescent Patients
2022, Arthroscopy, Sports Medicine, and RehabilitationUnique Considerations for the Pediatric Athlete During Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction
2022, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :Nonoperative or delayed surgical treatment was once the standard of care for the skeletally immature patient with ACL tear due to concerns of physeal injury and subsequent deformity. Current practice has evolved to favor early surgery with good functional outcomes, decreased meniscal and articular cartilage injuries, and improved rate of return to sports with minimal risk of growth disturbance.11,14,32-35 Surgical treatment for the skeletally immature includes physeal sparing, partial transphyseal, and transphyseal techniques.10,12
Anterior cruciate ligament tear patterns in young patients: An arthroscopic multicenter study
2021, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :Given the difficulty with nonoperative treatment in this population and the risk of recurrent instability causing further damage to the knee, ACL reconstruction is now considered the standard treatment for ACL tears in the pediatric patients.2,3 ACL reconstruction in the skeletally immature patient carries its own set of complications such as: growth arrest due to injury to the physis,4,5 re-rupture or contralateral ACL tear,6–9 and early onset of osteoarthritis.10,11 For these reasons, there has been renewed interest in various surgical techniques which try to preserve and heal the native ACL.12
The authors report no conflict of interest.